Bruce J Kirenga, Rupert Jones and Siân Williams Rapid Assessment of the Demand and Supply of Tobacco Dependence Pharmacotherapy in Uganda Bruce J Kirenga, Rupert Jones and Siân Williams

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Rationale Smoking cessation a key component of tobacco control Article 14 of the WHO Framework Convention on Tobacco Control (WHO FCTC) states that: “each Party … shall take effective measures to promote cessation of tobacco use and adequate treatment for tobacco dependence”

Background Population smoking prevalence in Uganda is low (7.9%) Increasing esp among young (Tobacco companies are targeting the young in Africa) Prevalence not known in patients with smoking related diseases Not known if tobacco dependence pharmacotherapy (TDP) is accessible and affordable 33% in Masindi 44% of COPD patients 30-39yr men 65% smoked

Aims To determine: the prevalence of current smoking among in-patients with a tobacco attributable disease (TAD) at Mulago hospital in Uganda. whether patients perceive that cost is a barrier to their use supply of TDP in pharmacies.

Methods: Supply and demand of TDP Demand: Survey of in patients with TADS: Chronic obstructive pulmonary diseases (COPD) Lung cancer Asthma Cardiovascular disease Stroke Diabetes. Supply: survey of Pharmacies on availability and cost of TDP

In patient survey methods Admitted from 1 June to 13 June 2015. Medical officer performed daily rounds on the wards to recruit patients. All consenting patients with a TAD were included. Data: smoking status duration of smoking products smoked willingness to quit willingness to pay for TDP.

Prevalence of smoking, desire to quit and willingness to pay for TDP Patient characteristics 66 invited; 56 participated 40 (71%) were male. Mean age 57.5 years Prevalence of smoking (n=56) 63% current smokers 36% former smokers 1.8% never smoker. Desire to quit and willingness to pay 77% desired to quit 37% willing to pay for the drugs.

Availability of TDPs 38 pharmacies were surveyed Availability of TDPs 36 private 1 public 1 private not for profit Availability of TDPs 7 (18%) pharmacies had any form NRT 3 had bupropion 1 had nortriptyline 0 had varenicline Mean cost for a month of: NRT $15.7 Buproprion $17.3

Summary and recommendations high prevalence of smoking in patients with a tobacco attributable disease high desire to quit high degree of willingness to pay very limited availability of TDP for Tobacco Control Framework to be implemented TDP should be made AVAILABLE and AFFORDABLE